Strengthening the HIV prevention continuum using pharmacies

摘要 艾滋病毒早期诊断是结束艾滋病毒流行战略的重要组成部分。然而，有一半的人 每年有近40,000名艾滋病毒检测呈阳性的美国人晚期(3期艾滋病)感染，这导致 更高的社区传播率和更差的治疗结果。在美国南部，艾滋病毒流行的地方 受影响不成比例的是，50%的艾滋病毒感染没有得到诊断。不频繁或延迟的艾滋病毒检测是最常见的 通常是由于缺乏医疗保健和对艾滋病毒的污名化态度阻碍了预防和治疗 寻找。因此，迫切需要增加艾滋病毒检测的获得和接受，以使艾滋病毒检测正常化并指导 如果检测HIV呈阴性，则个人接受暴露前预防(PrEP)，如果检测HIV，则接受HIV治疗 阳性。为了增加艾滋病毒检测的机会和接受度，我们建议将艾滋病毒预防服务 在艾滋病毒流行率较高的社区药店内。尽管前景看好 基于药房的艾滋病毒检测的可行性的证据，它并不广泛获得。事实上，大多数当地的药房 对于艾滋病毒检测是否在其业务范围内，董事会缺乏政策指导。我们的研究表明，艾滋病毒 如果社区药房提供不那么污名化的非艾滋病毒相关药物，就可以增加测试的接受率 服务(例如，COVID19、血压、血糖和胆固醇筛查)。但很多社区药房 工作人员报告说，培训不足是将艾滋病毒检测纳入药房工作系统的障碍。因此， 评估社区内艾滋病毒检测和预防服务的实施情况和成效 药房我们提出了一种混合型1型研究设计，旨在1)检查政策、药房工作人员和 客户一级的障碍和采用艾滋病毒预防服务的促进者(例如艾滋病毒检测、PrEP转诊、艾滋病毒 治疗转介)在社区药房，2)制定和实施药房工作人员艾滋病毒预防服务 (例如，艾滋病毒检测和咨询、PrEP转诊、艾滋病毒治疗转诊)培训，以及3)测试 将社区药房的艾滋病毒预防服务与现有的非艾滋病毒相关筛查相结合，与 那些没有有效和执行成果的国家。在探索、准备、 实施，可持续框架，这项研究将包括一个探索阶段，审查 美国南部使用在线方式提供以药房为基础的艾滋病毒预防服务的障碍和促进者 对社区药房工作人员的调查(n=300)，以及对药房委员会成员的深入访谈(n=16) 药房工作人员(n=40)。在准备阶段，开展了虚拟社区药房艾滋病预防培训 将被开发并提供给150名社区药房工作人员。最后，在执行和 在维持阶段，我们将评估艾滋病毒预防服务提供的可接受性和可持续性 在10家社区药房工作超过12个月(提供初级预防筛查的5家药房与5家 没有的药房)。研究结果将用于支持在社区推广艾滋病毒预防服务 在南方的药店里，迫切需要努力减少艾滋病毒的传播。

ABSTRACT Early HIV diagnosis is an essential component of the strategy to End the HIV Epidemic (EHE). Yet, half of the nearly 40,000 Americans who test positive for HIV every year have late (stage 3 AIDS) infection, which results in higher community transmission and poorer treatment outcomes. In the United States South, where HIV is disproportionately impacted, 50% of HIV infections are undiagnosed. Infrequent or delayed HIV testing is most often due to poor healthcare access and stigmatizing attitudes about HIV that inhibit prevention and treatment seeking. Thus, increased HIV testing access and uptake is urgently needed to normalize HIV testing and direct individuals to pre-exposure prophylaxis (PrEP) if they test HIV negative or HIV treatment if they test HIV positive. To increase HIV testing access and uptake, we propose integrating HIV prevention services within community pharmacies located in neighborhoods with high HIV prevalence. Despite promising evidence of feasibility of pharmacy-based HIV testing, it is not widely available. In fact, most local pharmacy boards lack policy guidance on HIV testing being within their scope of practice. Our work has shown that HIV testing uptake in community pharmacies can be increased if it is offered with less stigmatized non-HIV-related services (e.g., COVID19, blood pressure, glucose, and cholesterol screening). But many community pharmacy staff report inadequate training as barriers to integrating HIV testing into the pharmacy work system. Therefore, to evaluate the implementation and effectiveness of HIV testing and prevention services within community pharmacies we propose a hybrid type 1 study design that aims to 1) Examine the policy-, pharmacy staff- and client-level barriers and facilitators of adopting HIV prevention services (e.g., HIV testing, PrEP referral, HIV treatment referral) in community pharmacies, 2) Develop and implement pharmacy staff HIV prevention service (e.g., HIV testing and counseling, PrEP referral, HIV treatment referral) trainings, and 3) Test the effects of integrating HIV prevention services in community pharmacies with existing non-HIV-related screenings versus those without on effectiveness and implementation outcomes. Guided by the Exploration, Preparation, Implementation, Sustainment framework, this study will include an exploration phase that examines the barriers and facilitators to pharmacy-based HIV prevention service provision across the US South using online surveys of community pharmacy staff (n=300), and in-depth interviews of Board of pharmacy members (n=16) and pharmacy staff (n=40). In the preparation phase, a virtual community pharmacy HIV prevention training will be developed and offered to 150 community pharmacy staff. Finally, in the implementation and sustainment phase, we will evaluate the acceptability and sustainment of the HIV prevention service delivery over 12 months in 10 community pharmacies (5 pharmacies who offer primary prevention screenings vs. 5 pharmacies who do not). Findings will be used to support scaling HIV prevention services in community pharmacies in the South where efforts to reduce HIV transmission are desperately needed to EHE.